Contraception

What is contraception?

Women need advice and access to safe, reliable and affordable contraception. The decision to use specific types of contraception is influenced by a woman’s age, health, frequency of sexual activity, number of sexual partners, desire for future pregnancy and certain medical conditions.

I firmly believe that patients should be well informed about their options and feel comfortable discussing different contraceptive methods.

What contraceptive methods are available?

A vast array of contraceptive methods is available, including:

hormonal treatments such as pills, implants, vaginal rings and some intrauterine devices (IUD)

barrier methods such as condoms, cervical caps and diaphragms, and

tubal ligation or tubal blockage

A good relationship with your gynaecologist is essential in selecting the best contraceptive methods for your sexual and general health.

What is hormonal contraception?

Hormonal contraceptive methods prevent pregnancy by regulating or ceasing ovulation, thickening cervical mucus thereby preventing the sperm from reaching the egg, or thinning the lining of the uterus. It is important that hormonal contraceptive methods are prescribed, administered and monitored by a gynaecologist in order to maintain optimal reproductive and general health.

For example, Mirena IUD releases progestin once inserted into the uterus, which makes the cervical mucous thicker, the endometrium thinner and suppresses ovulation. Mirena has a lower risk of pelvic diseases and endometrial cancer than oestrogen-based contraceptive methods, and menstrual bleeding and pain are reduced within 3 to 6 months of insertion.

Some methods of hormonal contraception may be contraindicated for particular populations. For example, the combined oral contraceptive pills (the pill) is not recommended for women that smoke and are over 35 years old or for any woman with a history of blood clots, breast, liver or endometrial cancer or for women with high blood pressure.

Similarly, injectable hormonal birth control may cause bone density loss in some patients, and may either require supplementation of Vitamin D and calcium or cessation of use.

What is barrier contraception?

Barrier contraceptive methods work by preventing sperm from entering the uterus and therefore fertilising an egg. They are removable, and are often a good alternative for women that are not able to use hormonal contraceptive methods. Some products are disposable (such as male and female condoms which are discarded after one use), while some are reusable (such as diaphragms, cervical caps and contraceptive sponges).

Diaphragms, for example, need to be fitted and are discarded after 1-2 years. They should be refitted after pregnancy, dramatic weight gain or loss or pelvic surgery. Additionally, some barrier methods such as lamb skin condoms and spermicides do not protect from sexually transmitted infections (STIs). Occasionally, barrier products may cause irritation to some patients which may require the attention of a doctor. Therefore, it is important that patients understand the risks and challenges associated with each contraceptive method.

What is tubal ligation?

A more permanent contraceptive method is tubal ligation. This is a surgical procedure whereby the fallopian tubes are cut and tied, blocking the path between the ovaries and the uterus. This stops the sperm from reaching the egg and therefore prevents fertilisation. Alternatively, the fallopian tubes can be blocked with an implant causing a tubal blockage which has a similar effect.

Both tubal ligation and tubal blockage procedures may be reversible, but it is not always a successful procedure. For this reason, these contraceptive methods are usually performed after significant consultation, investigation and discussion with a physician.

Factors affecting the success of a reversal include age of the patient, number of previous abdominal surgeries and other medical history, the length of the tubes at the time of the procedure and the type of sterilisation procedure used. The chances of falling pregnant after a reversal procedure are about 60% with full term pregnancies achieved in about 50% of patients.